2022 MICRA Modernization Agreement


On May 16, 2022, Governor Gavin Newsom signed AB 35 (MICRA Modernization) into law. The Governor's action followed a bipartisan and nearly unanimous vote by the state Legislature. As part of the landmark agreement reflected in AB 35, proponents of FIPA have removed the initiative from the November ballot. The law will go into effect January 1, 2023. Under the modernized MICRA law, the underlying principles of MICRA were preserved -- ensuring access to care and protecting our health care delivery system from runaway costs.

The ‘Fairness for Injured Patients Act’, or FIPA, was the ballot initiative that set to end MICRA in November. FIPA would have effectively eliminated MICRA’s cap on non-economic damages by introducing a new broadly defined “catastrophic injury” category, made attorney’s fees additive on top of damages, and allowed trial lawyers to go after physicians’ personal assets. AB 35 makes significant, but much more modest, changes to MICRA’s cap on noneconomic damages, which is currently $250k and has not changed since MICRA was adopted in 1975:

  • Cases not involving a patient death will have a limit of $350k on the effective date of January 1, 2023, with an incremental increase over the next 10 years to $750k and a 2.0% annual inflationary adjustment thereafter. The cap
  • Cases involving a patient death will have a limit of $500k on the effective date of January 1, 2023, with an incremental increase over the next 10 years to $1 million and a 2.0% annual inflationary adjustment thereafter.

Critical MICRA guardrails will remain in place with modest updates include the ability to pay awards of future damages over time and limits on plaintiff’s attorney’s contingency fees. CMA has prepared a fact sheet that includes additional details on this important legislation.

Click here to read the full statement from CMA President, Robert E. Wailes, MD.

Defeating an Anti-MICRA Initiative in 2014

In 2014, trial lawyers sponsored an anti-MICRA initiative that appeared on the November 2014 ballot called Proposition 46.  Prop. 46 is a deceptive initiative that contains a number of unrelated provisions designed to mislead and deceive voters. Prop. 46 would weaken the Medical Injury Compensation Reform Act (MICRA), California's model medical malpractice reform law that keeps malpractice rates in California stable by limiting noneconomic damages in malpractice awards while providing unlimited economic and punitive damages. 

On November 4, 2014, the voters of California spoke loudly and definitively to defeat Prop. 46.  According to the Secretary of State’s current results, 67% of California voters said no to the trial lawyers’ deceitful proposition, and only 33% said yes.  Locally, 63% of Alameda County voters said no and only 36% said yes, and 65% of Contra Costa County voters said no and only 35% said yes.

This victory is a testament to the effectiveness of professional medical associations, which have steadfastly defended this assault on California’s tort reform – Medical Injury Compensation Reform Act (MICRA) – to preserve access to care and the ability of physicians to serve their patients.

The California Medical Association (CMA) was masterful in its response to trial lawyer vitriol, ensuring that our State Legislators and the public understood the ruse the trial lawyers were running and the consequences that their self-serving proposal would have for Californians.  CMA also effectively brought together one of the largest and most diverse coalitions ever amassed against a statewide proposition, from organized labor to the Chamber of Commerce, the ACLU, California NAACP, Planned Parenthood, local governments, taxpayer organizations, and on and on. CMA engaged editorial boards and political parties on both s ides of the aisle to understand the terrible consequences of Proposition 46 and oppose it.

Locally, the ACCMA engaged physicians, who were instrumental in conducting an effective grassroots effort to inform patients and the general public of why to vote no on Prop. 46, and ACCMA representatives engaged in numerous public forums to convey that message.  And the doctor-owned professional liability carriers in California, borne out of the ashes of a malpractice crisis in 1975 that sent malpractice awards skyrocketing to the point of forcing physicians to stop practicing medicine, provided instrumental support for the campaign along with numerous health care organizations throughout the state.

The medical profession should pat itself on the back for its role in the success of this campaign to defeat Prop. 46, and for investing in the medical associations so that they could do what they exist to do: promote health care access, quality of care, and be the voice of the medical profession on behalf of the patients they serve.

Why has MICRA Succeeded?

Prior to the MICRA reforms the cost of malpractice insurance in California was exceeded only by the cost for physicians practicing in New York City. Since MICRA’s passage the average national cost of malpractice coverage has increased by 854%, while California’s costs have risen only 287%. Current California malpractice insurance costs are in the lower half of rates among all states, and rates in Northern California are in the lower third among all states. In comparison to the states with the highest malpractice insurance premiums, none of which have MICRA reforms, rates in Southern California are about 40% of those rates, and rates for Northern California are almost half again lower than rates in Southern California.

Physicians Owned Insurers Malpractice Premium Comparison Chart, 2012

Important MICRA Links

CMA Resources

The MICRA Manual

MICRA Toolkit Talking Points - free for ACCMA/CMA members (login to access)

MICRA Toolkit Fact Sheet - free for ACCMA/CMA members (login to access)